Basic Information
Provider Information | |||||||||
NPI: | 1699139980 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MEINHARDT | ||||||||
FirstName: | SUMMER | ||||||||
MiddleName: | SANFORD | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SANFORD | ||||||||
OtherFirstName: | SUMMER | ||||||||
OtherMiddleName: | MICHELLE | ||||||||
OtherNamePrefix: | MISS | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 307 BOATNER RD STE 114 | ||||||||
Address2: |   | ||||||||
City: | EGLIN AFB | ||||||||
State: | FL | ||||||||
PostalCode: | 325421302 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8508838600 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 307 BOATNER RD | ||||||||
Address2: |   | ||||||||
City: | EGLIN AFB | ||||||||
State: | FL | ||||||||
PostalCode: | 325421302 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8508838600 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/12/2016 | ||||||||
LastUpdateDate: | 07/21/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/21/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | R5431 | TX | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
No ID Information.